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Overview

Rheumatoid arthritis (RA) is
the second most common type of arthritis, affecting
about 1.5 million Americans. It’s an inflammatory disease that’s caused
by an autoimmune condition. The disease occurs when your body attacks its own healthy
joint tissues. This results in redness, inflammation, and pain.

The main goal of RA drugs is to
block inflammation. This helps prevent joint damage. Read on to learn about the
many treatment options for RA.

DMARDs and biologics

Disease-modifying antirheumatic
drugs (DMARDs) are used to decrease inflammation. Unlike other medications that
temporarily ease pain and inflammation, DMARDs can slow the progression of RA.
This means that you may have fewer symptoms and less damage over time.

Biologics are injectable drugs. They
work by blocking specific inflammatory pathways made by immune cells. This
reduces inflammation caused by RA. Doctors prescribe biologics when DMARDs
alone aren’t enough to treat RA symptoms. Biologics aren’t recommended for
people with compromised immune systems or an infection. This is because they
can raise your risk of serious infections.

Janus associated kinase inhibitors

Your doctor may prescribe these
drugs if DMARDs or biologics don’t work for you. These medications affect genes
and the activity of immune cells in the body. They help prevent inflammation
and stop damage to joints and tissues.

Baricitinib is a new drug that’s
being tested. Studies suggest that it works for people who don’t have success with DMARDs.

The more common side effects of
these drugs include:

headache

upper
respiratory infections, like sinus infections or the common cold

congested
nose

runny nose

sore throat

diarrhea

Acetaminophen

Acetaminophen is
available over the counter (OTC) without a prescription from your doctor. It
comes as an oral drug and a rectal suppository. Other drugs are much more
effective at reducing inflammation and treating pain in RA. This is because
acetaminophen can treat mild to moderate pain, but it doesn’t have any anti-inflammatory
activity. This means it doesn’t work very well to treat RA.

This drug carries the risk of
serious liver problems, including liver failure. You should only take one drug
that contains acetaminophen at a time.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs are among the most
commonly used RA drugs. Unlike other pain relievers, NSAIDs seem to be more
effective in treating symptoms of RA. This is because they prevent
inflammation.

Some people use OTC NSAIDs.
However, stronger NSAIDs are available with a prescription.

Side effects of NSAIDs include:

stomach
irritation

ulcers

erosion or
burning a hole through your stomach or intestines

stomach bleeding

kidney
damage

In rare cases, these side effects
can be fatal (cause death). If you use NSAIDs for a long time, your doctor will
monitor your kidney function. This is especially likely if you already have
kidney disease.

Warning

People who are allergic to aspirin should not take NSAIDs.

Ibuprofen (Advil, Motrin IB, Nuprin)

OTC ibuprofen is the
most common NSAID. Unless instructed by your doctor, you should not use ibuprofen
for more than several days at a time. Taking this drug for too long can cause
stomach bleeding. This risk is greater in seniors.

Ibuprofen is available in
prescription strengths as well. In prescription versions, the dosage is higher.
Ibuprofen may also be combined with another type of pain drug called opioids. Examples
of these prescription combination drugs include:

Topical capsaicin (Capsin, Zostrix, Dolorac)

Diclofenac sodium topical gel (Voltaren 1%)

Voltaren gel 1% is an NSAID for topical use. This means you
rub it on your skin. It’s approved to treat joint pain, including in your hands
and knees.

This drug causes similar side
effects to oral NSAIDs. However, only about 4 percent of this drug is absorbed into
your body. This means that you may be less likely to have side effects.

Diclofenac sodium topical solution (Pennsaid 2%)

Diclofenac sodium (Pennsaid 2%) is a topical solution used for
knee pain. You rub it on your knee to relieve the pain.

Opioid pain drugs

Opioids are the strongest pain
drugs on the market. They’re only available as prescriptions drugs. They come
in oral and injectable forms. Opioids are only used in RA treatment for people with
severe RA who are in intense pain. These drugs can be habit-forming. If your
doctor gives you an opioid drug, they’ll watch you closely.

Corticosteroids

Corticosteroids are also called
steroids. They come as oral and injectable drugs. These drugs can help reduce
inflammation in RA. They may also help reduce the pain and damage caused by
inflammation. These drugs aren’t recommended for long-term use.

Immunosuppressants

These drugs fight off the damage
caused by autoimmune diseases such as RA. However, these drugs can also make
you more prone to illness and infection. If your doctor gives you one of these
drugs, they’ll watch you closely during treatment.

These drugs come in oral and
injectable forms. They include:

Alternative options

Omega-3 fatty acids may offer some benefit in reducing inflammation in your body. You can get omega-3s through your diet. For example, fish like sardines, halibut, and anchovies are high in omega-3s. Other foods like walnuts, canola oil, and ground flaxseed also contain smaller amounts of omega-3s. You can also take omega-3 supplements.

Takeaway

Work with your doctor to find the
RA treatment that works best for you. With so many options available, you and
your doctor are likely to find one that eases your RA symptoms and improves
your quality of life.

Rheumatoid arthritis is an autoimmune inflammatory arthritis. The word "auto" means self, so these are diseases in which the immune system attacks itself. Normally your immune system is not supposed to do that. It's supposed to attack viruses, bacteria, fight off infections, but in some people for whatever reason their immune system gets confused and attacks its own tissues. In the case of rheumatoid arthritis the immune system makes inflammation, the inflammation runs through the body and settles into certain areas, especially into the joints, and if it settles into those joints it can cause pain, swelling, stiffness, and over time that swelling has chemicals, which can cause destruction of bone underneath it, leading to deformity and disability.

Once a diagnosis of rheumatoid arthritis is made, depending on the severity we decide on the treatment path. Traditionally we use two groups of medications, the disease modifying medications referred to as DMARDS, and the biologic medications. Traditionally we start with a DMARD if the symptoms are relatively mild. If on the other hand the symptoms are more severe, we may start with a biologic medication. Oftentimes we find ourselves combining various combinations of these medications to get adequate control of the disease.

Disease modifying medications or DMARDS have been on the market for many years. They're oral medications that act on the immune system in a more general way. They act on overactive immune processes, whereas biologic medications, this newer group of medications, is much more specific targeted therapy.

One of the most important properties of our immune system is to make inflammation. Say for example you get a cut or a wound. It's your immune system that detects the danger and makes inflammation. Inflammation is made by a group of proteins referred to as cytokines. These are signaling proteins.They tell cells to make inflammation.

Some of the newer treatments referred to as biologic medications target specific pro-inflammatory cytokines. By preventing or inhibiting these inflammatory cytokines, inflammation is prevented from being made.

The majority of our patients actually are on various combinations of medications and to adequately control our patients oftentimes we combine these medications. Occasionally we get lucky. We find a patient that may be in the early stages or has very mild disease or has a great response to just an oral disease modifying medication. This happens in about a third of our patients, however two-thirds of our patients require various combinations of disease modifying medications or disease modifying medications plus a biologic.

Oftentimes we will often cycle through various biologics. If one biologic doesn't work, we may swap it out for another one to achieve better control of the disease.

If a patient has persistent joint pain, stiffness, or swelling, then they are most likely failing their current therapy. On the other hand, at times patients feel that their symptoms are adequately controlled, however there are certain objective measures that the rheumatologist monitors, and if those objective measures such as blood work, ultrasound, x-rays are showing persistent disease activity, then also we consider that the patient is failing current therapy. In either situation we try to dose adjust these patients or change medications to get better control of their disease process.

Rheumatoid arthritis is an autoimmune inflammatory arthritis. The word "auto" means self, so these are diseases in which the immune system attacks itself. Normally your immune system is not supposed to do that. It's supposed to attack viruses, bacteria, fight off infections, but in some people for whatever reason their immune system gets confused and attacks its own tissues. In the case of rheumatoid arthritis the immune system makes inflammation, the inflammation runs through the body and settles into certain areas, especially into the joints, and if it settles into those joints it can cause pain, swelling, stiffness, and over time that swelling has chemicals, which can cause destruction of bone underneath it, leading to deformity and disability.

Once a diagnosis of rheumatoid arthritis is made, depending on the severity we decide on the treatment path. Traditionally we use two groups of medications, the disease modifying medications referred to as DMARDS, and the biologic medications. Traditionally we start with a DMARD if the symptoms are relatively mild. If on the other hand the symptoms are more severe, we may start with a biologic medication. Oftentimes we find ourselves combining various combinations of these medications to get adequate control of the disease.

Disease modifying medications or DMARDS have been on the market for many years. They're oral medications that act on the immune system in a more general way. They act on overactive immune processes, whereas biologic medications, this newer group of medications, is much more specific targeted therapy.

One of the most important properties of our immune system is to make inflammation. Say for example you get a cut or a wound. It's your immune system that detects the danger and makes inflammation. Inflammation is made by a group of proteins referred to as cytokines. These are signaling proteins.They tell cells to make inflammation.

Some of the newer treatments referred to as biologic medications target specific pro-inflammatory cytokines. By preventing or inhibiting these inflammatory cytokines, inflammation is prevented from being made.

The majority of our patients actually are on various combinations of medications and to adequately control our patients oftentimes we combine these medications. Occasionally we get lucky. We find a patient that may be in the early stages or has very mild disease or has a great response to just an oral disease modifying medication. This happens in about a third of our patients, however two-thirds of our patients require various combinations of disease modifying medications or disease modifying medications plus a biologic.

Oftentimes we will often cycle through various biologics. If one biologic doesn't work, we may swap it out for another one to achieve better control of the disease.

If a patient has persistent joint pain, stiffness, or swelling, then they are most likely failing their current therapy. On the other hand, at times patients feel that their symptoms are adequately controlled, however there are certain objective measures that the rheumatologist monitors, and if those objective measures such as blood work, ultrasound, x-rays are showing persistent disease activity, then also we consider that the patient is failing current therapy. In either situation we try to dose adjust these patients or change medications to get better control of their disease process.

Article resources

Drug
therapy for rheumatoid arthritis in adults: An update. (2012, April 24).
Retrieved from
http://effectivehealthcare.ahrq.gov/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=1042